PROJECT SUMMARY Currently picture archiving and communications systems (PACS) in the OR available in computer workstations in operating rooms (OR) are accessible through traditional interfaces, e.g., touchscreens, keyboards, and mice. However, these can compromise sterility and spread infection. Gestures offer an attractive alternative for surgeon interaction, without compromising the sterile environment. The main obstacle with hand gesture based interfaces is the lack of analytical tools to determine the most efficient and useable gestures that are best fitted to surgical tasks. Currently, the most common practice is for a single individual (usually a system developer) to decide which gestures should be used by all surgeons. The disadvantage is that designers may not consider usability factors specific to image manipulation during surgery, or may only consider gestures suitable to a single surgeon. The researchers will develop a highly efficient, usable methodology for designing suitable gesture-based interfaces for the operating room. Using a rigorous methodology that includes input from an expert panel of surgeons on PACS requirements and operations, vocabulary acceptability criteria (VAC) will be identified and interface usability measures will be determined. Once the gesture vocabularies are designed, a gesture interface will be implemented within a specific group of users and tasks related to surgery. The researchers are uniquely suited to tackle these challenges by their expertise in and knowledge of hand gesture interface design, gesture communication, and medical imaging. In addition to offering an innovative sterile alternative that will promote a decrease in the spread of infection, which represents a substantial savings in medical costs, the proposed research will also improve the understanding of how natural means of interaction affect doctors' performance in the OR. Improved understanding of the factors affecting design and use of hand gesture interfaces, are key to introducing such interfaces in demanding, time-sensitive tasks, like the OR.